Abstract
BackgroundCompensatory-reserve-weighted intracranial pressure (wICP) has recently been suggested as a supplementary measure of intracranial pressure (ICP) in adult traumatic brain injury (TBI), with a single-center study suggesting an association with mortality at 6 months. No multi-center studies exist to validate this relationship. The goal was to compare wICP to ICP for association with outcome in a multi-center TBI cohort.MethodsUsing the Collaborative European Neuro Trauma Effectiveness Research in TBI (CENTER-TBI) high-resolution intensive care unit (ICU) cohort, we derived ICP and wICP (calculated as wICP = (1 − RAP) × ICP; where RAP is the compensatory reserve index derived from the moving correlation between pulse amplitude of ICP and ICP). Various univariate logistic regression models were created comparing ICP and wICP to dichotomized outcome at 6 to 12 months, based on Glasgow Outcome Score—Extended (GOSE) (alive/dead—GOSE ≥ 2/GOSE = 1; favorable/unfavorable—GOSE 5 to 8/GOSE 1 to 4, respectively). Models were compared using area under the receiver operating curves (AUC) and p values.ResultswICP displayed higher AUC compared to ICP on univariate regression for alive/dead outcome compared to mean ICP (AUC 0.712, 95% CI 0.615–0.810, p = 0.0002, and AUC 0.642, 95% CI 0.538–746, p < 0.0001, respectively; no significant difference on Delong’s test), and for favorable/unfavorable outcome (AUC 0.627, 95% CI 0.548–0.705, p = 0.015, and AUC 0.495, 95% CI 0.413–0.577, p = 0.059; significantly different using Delong’s test p = 0.002), with lower wICP values associated with improved outcomes (p < 0.05 for both). These relationships on univariate analysis held true even when comparing the wICP models with those containing both ICP and RAP integrated area under the curve over time (p < 0.05 for all via Delong’s test).ConclusionsCompensatory-reserve-weighted ICP displays superior outcome association for both alive/dead and favorable/unfavorable dichotomized outcomes in adult TBI, through univariate analysis. Lower wICP is associated with better global outcomes. The results of this study provide multi-center validation of those seen in a previous single-center study.
Highlights
Intracranial pressure (ICP) is well known to be associated with outcome in adult traumatic brain injury (TBI), with higher sustained levels of intracranial pressure (ICP) linked to worse global outcome, and higher mortality [1, 3, 5, 9, 11]
Lower weighted intracranial pressure (wICP) is associated with better global outcomes
Intracranial pressure (ICP) is well known to be associated with outcome in adult traumatic brain injury (TBI), with higher sustained levels of ICP linked to worse global outcome, and higher mortality [1, 3, 5, 9, 11]
Summary
Intracranial pressure (ICP) is well known to be associated with outcome in adult traumatic brain injury (TBI), with higher sustained levels of ICP linked to worse global outcome, and higher mortality [1, 3, 5, 9, 11]. Using information from the continuously updating cerebral compensatory reserve index (RAP) [2, 4, 12], derived from the moving correlation coefficient between pulse amplitude of ICP (AMP) and ICP, one can derive a “weighted” ICP (wICP) as wICP = (1 − RAP) × ICP [2, 6] Such characteristics of wICP have been described in detail within this previous work [2], with a strong association between wICP and mortality being seen on descriptive analysis. Despite the promise of wICP as a combined measure of ICP and compensatory reserve in adult TBI, these conclusions have been based on data from a single-center series [2, 6]. Compensatory-reserve-weighted intracranial pressure (wICP) has recently been suggested as a supplementary measure of intracranial pressure (ICP) in adult traumatic brain injury (TBI), with a single-center study suggesting an association with mortality at 6 months. The goal was to compare wICP to ICP for association with outcome in a multi-center TBI cohort
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